A blended sensor restores chronotropic response more favorably than an accelerometer alone in pacemaker patients: the LIFE study results.
BACKGROUND
Adaptive rate sensors used in permanent pacemakers incorporate an accelerometer (XL) to increase heart rate with activity. Limited data exists regarding the relative benefit of a blended sensor (BS) (XL and minute ventilation) versus XL alone in restoring chronotropic response (CR) in chronotropically incompetent (CI) patients.


METHODS
One thousand five hundred thirty-eight patients from the limiting chronotropic incompetence for pacemaker recipients (LIFE) study were implanted with a pacemaker and 1,256 patients had data collected at 1 month. Patients performed a treadmill test 1-month postimplant while programmed in nonrate responsive mode (DDD-60) to determine CI. Only patients who completed at least three exercise stages and achieved a peak perceived exertion >or=16 were included in the analyses. The metabolic chronotropic relationship (MCR) slope was used to evaluate CR in 547 patients. Patients were randomized to XL or BS with a conservative fixed rate response factor (XL = 8, MV = 4). CI patients performed a follow-up 6-month treadmill test.


RESULTS
CI prevalence in this patient population (n = 547) was 34%. No differences in baseline characteristics existed between groups. Although both groups showed significant within-group improvements in MCR slope from 1 to 6 months (both P < 0.001), the BS group had a significantly higher MCR slope at 6 months compared to the XL group (P = 0.011). Improvement in quality of life (QOL) did not differ between groups.


CONCLUSIONS
In this general pacemaker population with CI, a BS programmed empirically restores CR more favorably than an XL sensor programmed nominally. Further studies are needed to determine if individual sensor optimization would lead to improvement in functional capacity, higher MCR slopes, and QOL.
Coman
James
J
Hillcrest Medical Center, Tulsa, Oklahoma, USA. jamescoman@heartrhythminstitute.com
Freedman
Roger
R
Koplan
Bruce A
BA
Reeves
Russell
R
Santucci
Peter
P
Stolen
Kira Q
KQ
Kraus
Stacia M
SM
Meyer
Timothy E
TE
D000054:Acceleration; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000295:instrumentation* / Q000706:statistics & numerical data*; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D015995:Prevalence; D014159:Transducers / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology